Many severe injuries, especially head trauma resulting in concussions, spinal cord injuries, and orthopedic injuries affecting the shoulders and knees, occur at work.
However, you may need help finding a workers’ compensation doctor because few physicians near you take workers’ compensation patients. Indeed, we often discover that doctors included on physician panels offered by employers, workers’ comp insurers, and third-party claim administrators like Sedgwick, Gallagher Bassett, or PMA will not see occupational injury patients or only take a limited number.
Even if you find a doctor who accepts workers’ compensation, you may notice that doctor making derogatory comments about the workers’ compensation system and litigation process. This behavior may cause you to question the adequacy of the medical attention you receive and whether the physician wants to rush to declare you at maximum medical improvement (MMI) so they can remove themself from your case.
This article explains why so many doctors hate workers’ compensation (or, at least, act like they do) and refuse or are reluctant to treat injured employees.
You are not the problem. Instead, insurers’ continued efforts to frustrate the purposes of workers’ comp and the administrative burdens of litigation are the primary reasons many doctors dislike workers’ compensation.
Read on to learn more.
If you are looking for more answers to questions about workers’ compensation or think it’s time to hire an attorney for your occupational injury claim, call us at (804) 251-1620 or (757) 810-5614. We obtain workers’ comp benefits and settlements for injured employees in Virginia.
No.
Healthcare providers can contract and decide whom to treat like other professionals and businesses if the decision does not violate public policy or laws governing medical emergencies.
Although most medical students take the Hippocratic Oath and swear to care for the sick and promote good health on their way to becoming doctors, physicians have no obligation to treat everyone. Indeed, there are many times when physicians can refuse care, especially when there is no emergency.
A doctor, therefore, can refuse to treat workers’ compensation patients.
Our conversations with workers’ compensation doctors and available data and studies suggest these are the nine reasons physicians hate the workers’ comp system.
Doctors who provide medical attention to injured employees often must spend more time on non-clinical tasks, such as completing Attending Physician Reports (APRs), writing letters addressing disability status and the causation between the recommended medical treatment and the work accident, attorney conferences, attending depositions and trials, responding to subpoenas duces tecum, and in-person meetings or telephone calls with nurse case managers hired by insurance companies.
These non-clinical tasks take time away from other patients, potentially reducing doctors’ income while increasing their stress because of duties they may not enjoy.
Causation between the diagnosed injury and the work accident and the proper medical work restrictions are two of the most disputed issues in workers’ compensation claims.
State workers’ comp boards, such as the Virginia Workers’ Compensation Commission, heavily rely on the medical reports from authorized treating physicians and Independent Medical Evaluation (IME) doctors to make crucial decisions on these issues. These decisions determine whether you continue to receive workers’ compensation wage loss payments, including Temporary Total Disability (TTD) benefits, or obtain permanent partial disability (PPD) payments for permanent impairment from the work accident.
However, few physicians have received extensive training to figure out cause and effects or assess disability duration or return-to-work issues. Instead, doctors focus on diagnosing your medical condition, regardless of cause, and helping you heal.
This lack of knowledge and training makes many doctors hesitant to address work status, leading some to avoid workers’ comp patients altogether. Other physicians may treat injured employees but defer to other healthcare providers, such as functional capacity evaluation (FCE) companies, for return-to-work assessments.
Physicians often find themselves in no-win situations when dealing with workers’ compensation.
On the one hand, the insurance defense attorney or claim adjuster may allege the doctor is too claimant-friendly if the doctor recommends surgery or listens to the patient when prescribing work restrictions.
On the other hand, you may lose trust in your physician if they change their opinions after conversations with the insurance company or defense counsel. Or, as we have seen too often, the doctor says they cannot recommend surgery because the workers’ comp insurer says they will not pay for it.
These disagreements between you and the insurer may lead to litigation, where the doctor must testify and answer questions under oath, either at a deposition or at the workers’ compensation hearing.
During these proceedings, one (or both) parties’ attorneys may question and argue with the treating doctor. In addition, the insurer may confront your treating physician with the IME doctor’s report, which often harms your case and disagrees with your doctor’s opinions.
Generally, doctors, particularly surgeons, are not used to being questioned or told they are wrong.
To avoid this scenario, some physicians will refuse to see workers’ comp patients.
Countless fights can arise in workers’ compensation claims.
Disputes over the correct pre-injury average weekly wage, the relationship between the accident and injury, when you gave notice, which doctor to see, whether the employer can accommodate your restrictions, and whether prescribed treatment is reasonable and necessary arise often.
In addition, you may have to deal with a rude claim adjuster or an employer pressuring you to give up your work injury claim or return to work before you have healed, threatening your job if you do not.
Feeling like no one is listening to you and having to dig and claw your way through these disputes can leave you angry and cause emotional distress and suffering.
No matter how hard you try, it may be challenging to separate these feelings from your treatment. Indeed, these emotions and the added stress of the constant conflict may affect your recovery.
Doctors know this, so some refuse to treat workers’ comp patients or will only perform specific surgeries once the case settles.
A delay in medical treatment for your work injury may lead to a worse prognosis and prolonged recovery.
Workers’ compensation cases, however, are often marked by delays when the insurance company investigates compensability, conducts discovery to see if it has defenses to your work injury claim, or transfers your claim among adjusters or defense attorneys. Indeed, it can take months and a court’s intervention to get approval for something as routine as Magnetic Resonance Imaging (MRI).
Some doctors avoid workers’ comp patients because they know these delays affect your recovery, and they fear that you will hold them responsible for a less-than-optimal outcome.
Some workers’ compensation insurers may delay payment for medical treatment until the Commission (or your state’s workers’ comp agency) finds the treatment reasonable, necessary, and related to the work accident.
This delay can take months or even years if one party requests a review by the appellate court that has the power of judicial review over workers’ comp (the Court of Appeals of Virginia here).
Uncertainty over whether and when they will receive payment leads some doctors to limit the number of workers’ compensation patients they see (or refuse to see them altogether).
Unless the doctor’s practice contracts with the workers’ comp insurer, the Commission’s Medical Fee Schedule (MFS) dictates how much the insurer must pay for each service.
The MFS charges may be lower than what the doctor receives for the same treatment for non-workers’ compensation patients.
In addition, the doctor may have to pay the employees’ attorney a fee if the employee must prosecute the authorization and payment of a specific medical procedure.
You may see the term “secondary gain” if you read your medical reports. In addition, the term “malingering” may not be far behind.
The secondary gain concept refers to any advantage, including increased attention, disability payments, or release from unliked responsibilities or tasks, resulting from an injury or an illness. For example, an insurer may argue you are exaggerating your symptoms and seeking medical attention so you can demand a better workers’ compensation settlement.
Some doctors, whether from poor past experiences with injured employees, reviewing edited surveillance video footage provided by defense attorneys, or insurance company propaganda and pressure, believe secondary gain is a significant problem in workers’ compensation cases and refuse to get involved.
Non-compliance, a failure to adhere to the prescribed medical treatment, is a significant issue in some occupational injury and illness claims.
Indeed, missed appointments are common in workers’ comp for multiple reasons, including the insurer’s refusal to provide prompt authorization for appointments and the injured worker’s difficulty getting to and from visits when they do not have an Award Letter or income.
Instead of dealing with these gaps in their calendar, some doctors limit or reject workers’ compensation patients.
Money means little without health.
But the only way to recover and heal after a work accident is to find a doctor who accepts workers’ comp patients.
Our attorneys help you get the medical treatment you need for work-related injury and negotiate top-dollar settlements once your condition stabilizes.